Provider Demographics
NPI:1639590987
Name:ADULT AND GERIATRIC MEDICINE PLLC
Entity Type:Organization
Organization Name:ADULT AND GERIATRIC MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUBNA
Authorized Official - Middle Name:N
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-957-6036
Mailing Address - Street 1:PO BOX 97115
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98497-0115
Mailing Address - Country:US
Mailing Address - Phone:253-588-7911
Mailing Address - Fax:253-984-6774
Practice Address - Street 1:801 SW 150TH ST
Practice Address - Street 2:SUITE 230
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1855
Practice Address - Country:US
Practice Address - Phone:206-957-6036
Practice Address - Fax:206-257-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038733207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00038733OtherMEDICAL PROFESSIONAL LICENSE